Why 272,000 More Texans Were Uninsured in 2017 — and How We Can Fix This

On September 12, the U.S. Census released the newest numbers counting Americans without health insurance. Disappointingly, the data show that the number of uninsured Texans in 2017 was 272,000 more than in 2016. After three straight years of historic improvements in our uninsured rates, Texas backslid in 2017, leaving 4.82 million (17.3 percent) of Texans uninsured, the worst Texas rate since 2014.

With this setback in 2017, Texas still has both the largest number and percentage of uninsured residents in the United States.

Yet recent polls found that most Texans don’t know the uninsured rate here Texas is higher than other states—let alone that we have been ranked worst for many years. Just over one-third (34 percent) knew that Texas’ uninsured rate is higher than other states (in fact, highest in the U.S.). Another 19 percent of those polled thought Texas’ uninsured rate was about the same as other states, and 16 percent thought it was actually lower than most other states.

Year

Number of Uninsured Texans (all ages)

Share of Texans Uninsured

2013

5.7 million

22.1%

2014

5.0 million

19.1%

2015

4.6 million

17.1%

2016

4.5 million

16.6%

2017

4.8 million

17.3%

Increase from 2016

272,000

0.7 percentage point

Note: Percentage increase in 2017 is a statistically significant change from 2016.

Kids Do Better than Adults- But Texas Needs to do Much Better! A much smaller percentage of Texas kids ages 18 and under (10.7 percent or about 835,000kids) are uninsured than adults ages 19-64 (23.5 percent uninsured). Only 1.8 percent of seniors ages 65 and over are uninsured, due largely to coverage under Medicare. The difference between kids and adults is almost entirely due to the availability of public insurance from Medicaid and the Children’s Health Insurance Program (CHIP) for kids. Texans just doesn’t offer much Medicaid coverage to adults.

While much better than adult coverage rates, Texas children’s uninsured rate still leaves us at the bottom of the rankings among the states with the worst uninsured rates for children and teens.

Who Did Better, and One Big Reason Why. Texas is one of 14 states whose uninsured rate and number got worse in 2017. Our neighbors in Arkansas, New Mexico, and Louisiana all did better, either holding steady from 2016 (Arkansas) or improving. Louisiana dropped its uninsured by 87,000 to just 8.4 percent uninsured. These three states have all expanded coverage using federal Medicaid dollars for their lowest-income adults, while Texas has not. Texas leaders are leaving a golden opportunity on the table and have so far refused to expand Medicaid coverage like 34 states have done.

Among the 13 other states whose uninsured problems worsened in 2017 are nine others that have not yet covered their poorest working adults through an expansion option. States like Texas without any form of Medicaid expansion have no subsidized coverage for working-poor adults, because the Affordable Care Act (ACA, or Obamacare) subsidies are only available above the poverty line. The 34 states with a Medicaid-financed coverage program for poor adults gained a major head start over the remaining states (three more states are looking at expansion through legislation or ballot initiatives) by covering their lowest-income adults.

Texas’ disadvantage shows in our sky-high uninsured rates for working-age adults: about 23.5 percent of working-age adult Texans (ages 19 to 64) were uninsured in 2017, compared to a U.S. average of 12.1 percent.

Federal Policies Hurt Enrollment in Several Ways. For uninsured Americans who make enough money to be above the official poverty line, a list of other policy changes launched by the current federal administration have eaten away at the affordability of coverage, opportunities to sign up for coverage, and access to help enrolling. Texas lost “Navigators” and contractors whose job was to help with enrollment, renewal, and choosing an insurance plan. Federal officials slashed marketing and outreach and shortened the sign-up period by half. And, when the Administration eliminated payments to insurers to lower co-pays and deductibles, it drove up the premiums and deductibles for moderate-income families with incomes above the subsidy level. All these factors contributed to lower coverage rates for Texans above the poverty line in 2017.

Texans Expect Better from State and Feds. The same major poll found that Texans want state and federal government to do more about the uninsured: a majority (54%) of Texans want spending on health care programs to increase, with only K-12 education being a higher spending priority. Two-thirds of Texans (64%) say that the state is not doing enough to help low-income adult residents get needed health care, and the same majority (64%) favor expanding the state’s Medicaid program to cover more low-income adults. EHF/KFF Poll: June 15 release

Texas can do better by accepting billions in federal funds to cover working poor adults, and taking steps to stabilize our state insurance markets: this is the job of the state Legislature and Governor. Congress can reverse destructive federal health insurance policies that are driving down insurance coverage for middle-income Americans. To get the job done, the solid majority of Texans who want to see Austin and Washington do more must do their part by demanding action from elected officials as health care voters!

This is an increase compared to 2016, with the number of uninsured Texans rising by 272,000 from the 2016 number (Table A-5)

But, this is still 931,000 fewer uninsured Texans than in 2013. (Table A-5)

With this setback in 2017, Texas still has both the largest number (4.8 million)(Table A-5) and percentage (17.3 percent) (Table 6) of uninsured residents in the country.

Since 2013, our state’s uninsured rate has dropped a total of 4.8 (Table 6) percentage points, with 931,000 fewer uninsured Texans (Table A-5) since new ACA coverage options started up in 2014.

Background: This week’s data from the Census Bureau’s American Community Survey—with a massive sample size of about 3.3 million people across the U.S.—confirm with a much higher degree of accuracy what earlier, smaller-sized surveys had predicted. For more information or to schedule an interview with a CPPP expert please contact Oliver Bernstein at bernstein@cppp.org.

Stay tuned as Thursday (Sept. 13) the Census Bureau will release more American Community Survey data, including Texas-specific data about poverty and income. To better understand the difference between the two American Community Survey (ACS) and the Current Population Survey (CPS), view our side-by-side comparison.

Anne Dunkelberg oversees health care policy for CPPP. She focuses on policy and budget issues related to health care access and immigrants’ access to public benefits. She joined the Center in 1994 from the State Medicaid Director’s Office at the Texas Health and Human Services Commission. Anne is a founding member of the statewide Children’s Health Coverage Coalition (formerly the Texas CHIP Coalition) and the Cover Texas Now Coalition. She has been recognized by Families USA as an outstanding Consumer Health Advocate and by the LBJ School of Public Affairs Alumni Association as a Distinguished Public Servant. She was the primary author of the first edition of Texas Medicaid in Perspective (“the Pink Book”) and serves on the Texas Medicaid Managed Care Statewide advisory committee and the Texas Healthcare Transformation Waiver Executive Waiver Committee. Anne is a native Texan, and received her B.A. from the University of Texas at Austin, and her M.P.A. from the LBJ School of Public Affairs at the University of Texas at Austin.